Solitary Fibrous Tumor Of Pleura Research Articles

Successful resection of a hypervascular paravertebral solitary fibrous tumor of pleura preserving the artery of Adamkiewicz, which was detected on preoperative angiography

BackgroundSolitary fibrous tumor of the pleura is rarely observed, accounting for 1% of all mediastinum tumors. There have been only a few reports of preoperative embolization for hypervascular tumors around the artery of Adamkiewicz (AKA). We report a rare case of solitary fibrous tumor for which transcatheter embolization was successfully performed before surgical resection.Case presentationA 66-year-old woman with sudden-onset back pain was referred to our hospital for the evaluation of a left intrathoracic abnormal shadow on chest X-ray. Preoperative computed tomography (CT) showed a large, posterior mediastinal, paravertebral, and well-demarcated mass with high contrast enhancement and significant vascularization fed by the intercostal artery (ICA), measuring 8.1 × 7.6 × 6.4 cm. Therefore, solitary fibrous tumor, unicentric Castleman disease, or paraganglioma was included in the differential diagnosis. The patient underwent preoperative transcatheter arterial embolization followed by surgical extirpation. Thanks to the appropriate assessment of the anatomy, we could resect the tumor safely. The pathological diagnosis was solitary fibrous tumor of pleura.ConclusionsWe recommend preoperative transcatheter arterial embolization (TAE) for hypervascular tumors close to the AKA that may require surgical removal; to reduce intraoperative hemorrhage, the AKA should be accurately detected during surgery.

SOLITARY FIBROUS SARCOMA: LATE PRESENTATION WITH DIRE EFFECTS

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: A 73-year-old woman with history of breast cancer status post radiation and chemotherapy was eval-uated in our emergency department (ED) for left sided chest pain that worsened over the previous month. She had two weeks of progressive physical limitation, and developed orthopnea the night prior which prompted her to seek care. CASE PRESENTATION: In the ED she was noted to have unrelenting left sided pleuritic chest pain. Physical exam was nota-ble for diminished breath sounds on the left side. Computed tomography (CT) scan of her chest re-vealed a 9.7 x 5.5 cm left lung mass with an associated complex loculated effusion. A left sided chest tube was placed for the loculated pleural effusion. It was exudative by Light's criteria, and pleural flu-id hematocrit was consistent with a hemothorax. She underwent a biopsy of the left lung mass which demonstrated CD34, BCL2, STAT6, spindle cell features and staghorn vasculature indicating a ma-lignant solitary fibrous sarcoma (SFS). She eventually underwent resection as an outpatient once staging confirmed no distant metastatic disease. DISCUSSION: The majority of thoracic solitary fibrous tumors (SFTs) are asymptomatic benign intrathoracic masses discovered incidentally on chest imaging. SFS are a malignant subtype of SFT [1]. Our case demon-strates a rare finding of a large left sided malignant solitary fibrous sarcoma that presented with a large hemothorax. SFTs generally arise from CD34+ dendritic mesenchymal cells which are present in nearly all connective tissues [2]. Association with pleural effusion may be associated with an in-creased risk of a malignant tumor [3]. The presence of a hemothorax has also been reported to cor-relate with rapid tumor enlargement [3]. STAT6, CD34, BCL2 are the most commonly found positive markers, with STAT6 sensitivity being reported as high as 100% [4]. CONCLUSIONS: Our patient did have a history of radiation treatment for left sided breast cancer which has been im-plicated in the development of SFS, particularly in the same radiation fields [5, 6]. Prognosis is usual-ly unpredictable with surgery being the gold standard in treatment [7]. In malignant tumors, chemo-therapy and radiation have limited efficacy [7]. Recurrence rates in malignant SFS are high even with complete resection, reported to be around 63% [8]. REFERENCE #1: Davanzo B, Emerson RE, Lisy M, Koniaris LG, Kays JK. Solitary fibrous tumor. Transl Gastroente-rol Hepatol. 2018 Nov 21;3:94. doi: 10.21037/tgh.2018.11.02. PMID: 30603730; PMCID: PMC6286917. REFERENCE #2: Zuo Z, Zhou H, Sun Y, Mao Q, Zhang Y, Gao X. Rapidly growing solitary fibrous tumors of the pleura: a case report and review of the literature. Ann Transl Med. 2020 Jul;8(14):890. doi: 10.21037/atm-20-4974. PMID: 32793734; PMCID: PMC7396790. REFERENCE #3: Tan JH, Hsu AA. Challenges in diagnosis and management of giant solitary fibrous tumour of pleu-ra: a case report. BMC Pulm Med 2016;16:114. 10.1186/s12890-016-0279-0. REFERENCE #4: Zhang P, Xiong K, Lv P, et al. Malignant solitary fibrous tumor occurring in the mediastinal pleura showing NAB2ex4-STAT6ex2 fusion and negative STAT6 immunohistochemistry: A case report. Thorac Cancer 2020;11:1344-9. 10.1111/1759-7714.13395. REFERENCE #5: Rubino C, Shamsaldin A, Lê MG, Labbé M, Guinebretière JM, Chavaudra J, de Vathaire F. Radia-tion dose and risk of soft tissue and bone sarcoma after breast cancer treatment. Breast Cancer Res Treat. 2005;89(3):277–288. doi: 10.1007/s10549-004-2472-8. REFERENCE #6: Karlsson P, Holmberg E, Johansson KA, Kindblom LG, Carstensen J, Wallgren A. Soft tissue sar-coma after treatment for breast cancer. Radiother Oncol. 1996;38(1):25–31. doi: 10.1016/0167-8140(95)01663-5. REFERENCE #7: Ronchi et al., "Extrapleural Solitary Fibrous Tumor: A Distinct Entity from Pleural Solitary Fibrous Tumor. An Update on Clinical, Molecular and Diagnostic Features. REFERENCE #8: Boothe JT, Budd GT, Smolkin MB, et al. Durable Near-Complete Response to Anti-PD-1 Check-point Immunotherapy in a Refractory Malignant Solitary Fibrous Tumor of the Pleura. Case Rep Oncol 2017;10:998-1005. 10.1159/000484041. DISCLOSURES: No relevant relationships by Danish Ahmad, source=Web Response No relevant relationships by Saad Ashraf, source=Web Response No relevant relationships by Fiyad Haniff, source=Web Response no disclosure on file for Jennifer Toth

Solitary fibrous tumor of the pleura with Doege-Potter syndrome.

Solitary fibrous tumor of pleura (SFTP) is a rare tumor. Complete tumor resection is the curative treatment and the key to preventing recurrence.
 We present here the case of a 65-year-old female diagnosed with a Doege-Potter syndrome who underwent resection of pleural solitary fibrous tumor.

Case report: uniportal video-assisted thoracoscopic resection of a solitary fibrous tumor preoperatively predicted visceral pleura origin using dynamic chest radiography

BackgroundDynamic chest radiography (DCR) is a flat-panel detector (FPD)-based functional X-ray imaging, which is performed as an additional examination in chest radiography. DCR provides objective and quantifiable information, such as diaphragm movement, pulmonary ventilation and circulation, and is reasonable for detecting tumor invasion or adhesion.Case presentationWe present a case of Solitary Fibrous Tumor of Pleura (SFTP), preoperatively predicted visceral pleura origin using Dynamic chest radiography (DCR) and surgically resected through single-access (uniportal) video-assisted thoracoscopic surgery (UVATS).ConclusionsUVATS may be a suitable surgical option for pedunculated SFTPs. Dynamic chest radiography provides information, such as tumor invasion or adhesion and helpful for predicting origin of the tumor.

[Solitary fibrous tumor of pleura (symptoms, diagnosis, treatment)].

Optimization of diagnosis and treatment of patients with solitary fibrous tumor of pleura, analysis of overall survival and disease-free survival, predictors of recurrence. There were 66 patients with solitary fibrous tumor of pleura (26 men and 40 women) aged 57.6 years (range 26-80 years). Asymptomatic course was found in 29 (44%) patients, various symptoms - in 37 (56%) patients. Thoracotomy was applied in 36 patients, thoracoscopy - in 30 patients. Immunohistochemical examination included analysis of definition of Stat6 expression. Benign variant of SFT was diagnosed in 50 (75.7%) patients, malignant variant - in 16 (24.3%) patients. STAT6 expression was observed in all cases. Postoperative morbidity was 9%, mortality - 1.6%. Recurrence was diagnosed in 2 (4%) patients with benign variant of disease and in 5 (31.2%) patients with malignant variant (2 of them died from progression of disease). Progression-free survival was 89.4%, overall survival - 95.4%. Predictors of recurrence are tumor dimension over 10 cm, necrosis and/or hemorrhagic component of tumor, mitotic count of at least four per 10 high-power fields. Olitary fibrous tumor of pleura is a rare mesenchymal fibroblastic neoplasm growing from submesothelial layer. Differential and preoperative morphological diagnosis of SFT is difficult and demands a special immunohistochemical examination with analysis of Stat 6 expression. Surgery is preferred for tumor de novo and recurrent neoplasm.

Perioperative management of a giant solitary fibrous tumor of Pleura.

Perioperative management of a giant solitary fibrous tumor of Pleura.

Huge solitary fibrous tumor of pleura

A 60-year-old male presented with dyspnea and chest pain. He was referred with massive bulky mass. A mass in the left lung was observed using chest X-ray (Figures 1).  A computed tomography scan of the chest showed a mass on the left lung with complete lung collapse Figures 2 (A, B). The needle biopsy was performed and the case was diagnosed with solitary fibrous tumor. Subsequently, the patient underwent complete resected open thoracotomy. In our case, the mass dimension was 50 × 35 cm weighting 5.600 gr Figures 3 (A,B).

Surgical outcomes and clinical courses of solitary fibrous tumors of pleura.

This study's aim is to define the clinicopathological and surgical outcomes, clinical courses, and results of long-term follow-up of cases that underwent surgical treatment for solitary fibrous tumors of the pleura (SFTp). Clinical and long-term follow-up records of 16 consecutive patients who had surgery for SFTp between 2006 and 2016 were reviewed in the retrospective chart review. There were nine males (56%) and seven (44%) females with an average age of 60.5 ± 17.1 (range 30-87 years). Etiological factors, diagnostic procedures, clinical and surgical outcomes, 5-year overall survival (OS), and disease-free survival (DFS) in these patients were researched. There was no remarkable common etiological factor. Nine of the cases were asymptomatic. Other symptoms were chest pain, dyspnea, cough and hypertrophic osteoarthropathy, respectively. Thoracotomy for the removal of pleural mass was carried out in 15 (94%) cases. Additional resection procedures included the chest wall resection in two cases and lobectomy in two. Video-assisted thoracoscopic surgery (VATS) resection was performed in one (6%) case. Complete surgical excision was performed in 74% of cases. Nineteen percent of cases were malignant SFTp (mSFTp). One of the mSFTp cases died in the 19th month after the diagnosis. The mean follow-up time was 50.6 ± 34.2 months (2--114 months). Mean survival of mSFTp patients was 40.6 ± 19.08 months (19--55 months) and that for benign SFTp (bSFTp) was 52.9 ± 37.05 months (2--114 months). Five-year OS--DFS were 93.5% and 74%, respectively. SFTp is an uncommon benign neoplasm but it can have malignant features. Even in the case of recurrence, the main treatment is total surgical excision. Oncologic treatments can be tried in unresectable and metastatic cases. VATS can be used in surgical total excision for small diameter and appropriate tumors. Understanding the nature of these tumors, immunohistochemical, and genetic studies may be a guide in future.

Paraneoplastična hipoglikemija kod pacijenta sa recidivom fibroznog tumora pleure

BACKGROUND: Solitary fibrous tumor of pleura represents a prototypical mesenchymal neoplasm that induces non-islet cell tumor hypoglycemia due to overproduction of insulin-like growth factor 2, named Doege Potter syndrome. CASE PRESENTATION: An 86-year-old man, non-diabetic, was admitted to hospital with a few months history of repetitive hypoglycemic symptoms and documented low blood glucose of 1.9 and 1.2 mmol/L on two occasions when he lost consciousness. His medical history was notable for primary pleural fibroma which was resected twenty years previously and for tumorous mass of right pulmonal lobe 103mm described on CT chest scan for respiratory infection six months prior to hospitalization. During hospitalization hypocorticism and hypoptuitarism were ruled out. He spontaneously developed mild neuroglycopenic episodes, when we confirmed hypoinsulinemic hypoglycemia accompanied with suppressed levels of growth hormone and IGF1, and IGF2 : IGF1 ratio of 7, which was all suggestive of paraneoplastic etiology. The response of glucose in Glucagon test was adequate. Beta-hydroxybutyrate was not done due to technical limitations. Abdominal MRI showed a few well-circumscribed cysts in the liver and hemangioma. Octreoscan revealed zone of diffuse increased uptake in right hemithorax. Subsequently, he was started on prednisolon for COPD exacerbation with which his hypoglycemic episodes subsided. Patient declined surgery and he was released with corticosteroid therapy. CONCLUSIONS: We report a case of hypoinsulinemic hypoglycemia in a patient with suppressed levels of hGH and IGF1 and higher-than-normal IGF2 : IGF1 ratio, along with recurrent pleural tumor which is somatostatine-receptor positive.

DOEGE-POTTER SYNDROME: EXPANDING THE DIFFERENTIAL DIAGNOSIS OF HYPOGLYCEMIA

SESSION TITLE: Disorders of the Pleura 2 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 pm - 02:15 pm INTRODUCTION: Hypoglycemia due to solitary fibrous tumor of pleura (SFTPs) is known as Doege-Potter syndrome (DPS). SFTPs are rare mesenchymal tumors that are asymptomatic or demonstrate nonspecific symptoms. They can ectopically secrete insulin-like growth factor II (IGF-II) causing hypoglycemia. DPS occurs in less than 5% of SFTP cases with less than 80 cases reported.1 CASE PRESENTATION: Herein, we report a case of recurrent malignant solitary fibrous tumor in a 54-year-old woman who had her first tumor resected 8 years prior without recurrence for 5 years on surveillance imaging. She presented with confusion, severe hypoglycemia, weight loss and digital clubbing. Computed tomography of the chest revealed recurrence of the mass measuring 13.8x9.6x13.6cm. Insulin, proinsulin, and C-peptide levels were undetectable. IGF-II was elevated at 690mg/ml. She was successfully managed with steroids.She subsequently underwent repeat thoracotomy with excision of the mass including visceral pleural, rib section, and pericardium. Histology was consistent with recurrence of malignant solitary fibrous tumor. IGF-II level dropped to 248ng/ml. Her hypoglycemia completely resolved after excision and prednisone taper. DISCUSSION: SFTPs are generally benign tumors but there is a risk of malignant transformation and recurrence. Definitive treatment and amelioration of associated hypoglycemia is achieved by local control of the mass with surgical resection. Prior to resection, hypoglycemia can be managed with glucocorticoids often requiring more than 20mg/day of prednisolone.1 There is no consensus on the use of adjunctive chemoradiation, however it has been utilized in malignant SFTP treatment. 1,2 Prognosis for malignant SFTP is favorable with surgical resection, with reported 5-year survival of 81%.2 CONCLUSIONS: Our case emphasizes the importance of expanding the differential diagnosis for hypoglycemia. Tumor-induced hypoglycemia should be investigated after ruling out common etiologies. SFTs have a good clinical outcome if complete resection is performed with resolution of DPS. Recurrence is not uncommon, therefore life-long surveillance with imaging may be beneficial. Reference #1: Han G, Zhang Z, Shen X, Wang K, Zhao Y, He J, Gao Y, Shan X, Xin G, Li C, Liu X. Doege–Potter syndrome: A review of the literature including a new case report. Medicine. 2017 Jul;96(27). Reference #2: Lococo F, Cesario A, Cardillo G et al: Malignant solitary fibrous tumors of the pleura: retrospective review of a multicenter series. J Thorac Oncol, 2012; 7: 1698–706 DISCLOSURES: No relevant relationships by Rayan Ihle, source=Web Response No relevant relationships by Muhammad Farhan Khaliq, source=Web Response

Giant solitary fibrous tumor of pleura revealed by epileptic seizures: A case report

Giant solitary fibrous tumor of pleura revealed by epileptic seizures: A case report

Solitary fibrous tumour of pleura: CT differentiation of benign and malignant types

To analyse and compare the computed tomography (CT) features of benign and malignant types of histopathologically proven cases of solitary fibrous tumours of pleura (SFTP). Retrospective analysis of preoperative CT images of 28 cases of histopathologically proven and classified SFTP from three participating institutions was performed. Patient demographics and lesion characteristics including size, borders, presence of a pedicle, extension into the fissure, attenuation, enhancement, pleural effusion, and calcifications were recorded and correlated with the final histopathological diagnosis. Type and results of preoperative biopsy were also recorded. Follow-up imaging and the clinical charts were reviewed to identify recurrence. Out of 28 cases (15 women and 13 men), 18 were proven to be benign and 10 were malignant. The mean age of patients was 58.1±15.9 and 66.5±11.8 years (p=0.1564) for benign and malignant tumours, respectively. The median (interquartile range) diameter was 6.05 (3.2-10.9) cm for benign and 15.7 (7.1-17.5) cm for malignant type tumours (p=0.0291). Tumours had lobulate borders in 28% (5/18) of benign cases and in 80% (8/10) of malignant cases (p=0.0163). Extension into adjacent fissure was seen in 22% (4/18) of benign lesions and 40% (4/10) of malignant lesions (p=0.40). A pedicle was present in 17% (3/18) of benign and 10% (1/10) of malignant lesions (p=1). Heterogeneous attenuation was present in 61% (11/18) of benign and 90% (9/10) of malignant lesions (p=0.19). Calcification was present in 17% (3/18) of benign tumours and in 70% (7/10) of malignant tumours (p=0.0113). Pleural effusion was present in 6% (1/18) of benign and 40% (4/10) of malignant lesions (p=0.04). Only 1/13 preoperative fine-needle aspirates yielded diagnosis of SFTP. Preoperative diagnosis of SFTP was made in all cases (11/11) with core biopsies. At follow-up (1-10 years, mean 3 years), local recurrence occurred in 3/6 (50%) patients with malignant SFTP and in none of the 10 patients with benign SFTP. No definite imaging feature to differentiate benign from malignant SFTP was found. Large size, lobulate borders, presence of calcification, and ipsilateral pleural effusion were the only CT features predictive of malignancy. In suspected cases, core biopsies should be performed rather than fine-needle aspiration.

Management of solitary fibrous tumor of the pleura: a rare differential of solid lung masses

Solitary fibrous tumors of pleura are uncommon. Sometimes they pose challenge to differentiate from lung cancer. Here, we are briefly discussing about the literature review and management principles in relation to our experience. A total of three patients were presented in thoracic oncology unit of Rajiv Gandhi Cancer Institute in the last year. Correct diagnosis is the key as surgical resection is often curative and surgical resection is often possible despite huge sizes. Our aim is to highlight this uncommon entity and to gain some insight into its management.

P3.04-039 Solitary Fibrous Tumor of the Pleura Associated with Gynecomastia: A Case Report: Topic: Miscellaneous II

Fibrous tumor originated from pleura is a rarely seen lung tumor. It can be malignant or benign, and may cause paraneoplastic syndromes. In this study, we retrospectively evaluated a case in which a lung mass was detected during examination of the gynecomastia and operated in our hospital with the diagnosis of solitary fibrous tumor of the pleura. 53-year-old male patient was admitted to our clinic with the complaint of bilateral painful breast enlargement. Symmetrical gynecomastia with benign findings was detected in Category 2 level according to Breast Imaging-Reporting and Data System (BI-RADS) classification in the bilateral breast ultrasonography investigations. Thorax computed tomography imagination showed extrapleurally located mass lesion with solid character and 75x25mm in size. Mesothelial cells were observed in the material received by the computed tomography-guided needle biopsy. Thereupon, a decision was made to take the patient to the operation. Frozen section procedure was performed on the specimen received by video-assisted thoracic surgery (VATS) biopsy. Diagnosis could not be achieved therefore it was decided to perform resection by mini-thoracotomy due to the size and rigid structure of the mass. During the process, it was observed that fibrous mass was holding on to the right middle lobe with a pedicle and it was found to be free in the other regions. The entire mass was removed with the resection including the surrounding healthy parenchymal tissue and the operation was terminated. The patient was discharged on the postoperative day 3. In the pathological examination, a solitary fibrous tumor associated with visceral pleura in the dimensions of 85×55×27 mm was reported with the features of low mitotic activity, and focal hypercellularity, and showing strong positive staining for CD34, CD99 and Bcl-2. In the additional investigations in gynecomastia clinics, it was observed that tumor cells were stained at 67-70% with progesterone and 35-40% with estrogen. Staining with β-Hcg was not observed. Solitary fibrous tumors of pleura is rare. These tumors originate from mesenchymal cells, not from mesothelial cells. These solitary fibrous tumors may be malignant or benign. These tumors may be asymptomatic, may cause symptoms of pressure or may lead to paraneoplastic syndromes. Recurrence can happen. Appropriate surgical intervention should be selected.

A rare case of malignant solitary fibrous tumour of pleura with Doege-Potter syndrome

Solitary fibrous tumour of pleura (SFTP) is a rare tumor contributing to less than 5% of all pleural tumours and about 10% 30% of these tumours show features of malignancy. Occurrence of hypoglycaemia with solitary fibrous tumour is an unusual paraneoplastic syndrome designated as Doege-Potter syndrome which can occur both in benign and malignant tumours. Very few cases of solitary fibrous tumour with Doege-Potter syndrome are documented in world literature and only a couple of cases are documented in Indian literature so far. We, report here an interesting case of 40-year-old male who presented with a short history of weakness in left upper and lower limbs following an ischaemic stroke; breathlessness, productive cough, seizures and repeated episodes of loss of consciousness. Laboratory investigation revealed normal serum C-peptide level (1.04 ng/mL) and his blood sugar level was observed to be low varying from 25 mg/dL to 47 mg/dL. Computed tomography (CT) of lung and pleura showed a large mass in right hemithorax for which he underwent right hemithoracotomy. Histopathological examination of the resected thoracotomy specimen along with immunohistochemical analysis confirmed the diagnosis of malignant solitary fibrous tumour of pleura. Basing on the clinical, histopathological and immunohistochemical examination findings, the case was finally diagnosed as malignant solitary fibrous tumour of pleura with Doege-Potter syndrome. The clinico-pathological features and therapeutic management of such rare syndrome are being discussed here.

A Rare Diagnosis in Pulmonary Pathology, Solitary Fibrous Tumor of Pleura: Report of Two Cases

A Rare Diagnosis in Pulmonary Pathology, Solitary Fibrous Tumor of Pleura: Report of Two Cases

Hypoglycemia Observed on Continuous Glucose Monitoring Associated With IGF-2-Producing Solitary Fibrous Tumor

Tumors producing IGF-2 (IGF-2oma) are a major cause of spontaneous hypoglycemia. The treatment mainstay is surgical resection. Many case reports note resolution of hypoglycemia after IGF-2oma resection; however, outcomes are variable according to tumor type. We report a case of resolving hypoglycemia, observed on continuous glucose monitoring, after resection of an IGF-2-producing solitary fibrous tumor of pleura and review the current literature. A 69-year-old woman presented with impaired consciousness because of hypoglycemia. An IGF-2oma was diagnosed as the cause for hypoglycemia because of decreased serum insulin and IGF-1, the presence of a pleural tumor, and a high-molecular-weight form of serum IGF-2 detected by Western immunoblot. Surgical resection was performed; pathological examination demonstrated a solitary fibrous tumor with low-grade malignancy. Continuous glucose monitoring showed reversal of hypoglycemia after tumor resection. Approximately 2 years after resection, the patient has no signs of tumor recurrence or hypoglycemia. An IGF-2-producing solitary fibrous tumor of pleura in this case caused hypoglycemia. From a search of the literature of 2004-2014, 32 cases of IGF-2oma with hypoglycemia that underwent radical surgery were identified; in 19 (59%) patients, hypoglycemia was reversed, and there was no subsequent recurrence. The remaining 13 (41%) patients experienced tumor recurrence or metastasis an average of 43 months after initial tumor resection. The tumor of the present case was a low-grade malignancy. Regular follow-up with biomarker monitoring of glucose metabolism and assessment of hypoglycemic symptomatology, in conjunction with imaging tests, is important for detecting possible tumor recurrence and metastasis.

Solitary fibrous tumors of pleura and lung: report of twelve cases.

Solitary fibrous tumors (SFTs) of pleura and lung are rare primary tumors that arise from the submesothelial tissue and usually show a benign clinical course. Immuno-histochemical analysis is used to make the diagnosis. We have reviewed our experience to obtain a better understanding of this disease. In this study, we reviewed 12 patients who had undergone a surgical resection for treatment of benign solitary fibrous tumors (SFTs) of pleura and lung during the period from 2006 to 2012. Following excision, the most essential characteristic on histopathology was nonatypical spindle-shaped tumor cells on a collagenous background. Keloid-type collagen, hypocellular and hypercellular areas could be observed in all the cases. On immuno-histochemical analysis, we found that mesenchymal markers such as CD34, bcl-2 and vimentin were positive, and S-100 protein and desmin were negative. In addition, Ki-67 was positive in approximately 5% of the tumor cells, but C-kit protein was not detected. If the result for CD34 was negative, expression of bcl-2 was positive. Complete resection was performed through thoracotomy, including 8 cases that involved video-assisted thoracic surgery (VATS). The postoperative courses were uneventful, and there was no recurrence during 3-65 (mean 25) months of follow-up. Complete resection of SFTs is usually curative. Morphological and pathological features are important in distinguishing them from other tumors and in predicting clinical behaviour.

Tumor fibroso solitario de la pleura asociado a síndromes paraneoplásicos

Solitary fibrous tumor of pleura associated with paraneoplastic syndromes Introduction: Solitary fibrous tumors of pleura (SFTP) are occasionally associated with paraneoplastic syndromes such as hypoglycemia and diffuse skeletal hyperostosis. Clinical case: We report a 60 years old male presenting with episodes of disorientation and inappropriate behavior, along with cough and weight loss. On physical examination there was digital clubbing. A chest X ray showed a big tumor in the right he- mithorax. Fasting blood glucose was 24 mg/dl and erythrocyte sedimentation rate was elevated. Large bone X rays showed hyperostosis. A needle biopsy of the tumor showed a SFTP. The tumor was excised and the final pathological diagnosis was a benign SFTP. Hypoglycemia subsided after surgery. After four months of follow up, finger clubbing was disappearing.

Resection of a giant, invasive malignant solitary fibrous tumor of pleura

Solitary fibrous tumor of pleura (SFTP) is a rare mesenchymal neoplasm that most commonly involves the pleura, is probably derived from fibroblasts, and has no relationship to malignant mesothelioma. Here, we report a case of complete resection of a giant malignant SFTP. A 61-year-old woman developed fever and left flank pain. Computed tomography revealed the tumor to be 13 cm in size and located in the left thoracic cavity, directly invading the left lower lobe of the lung. The patient underwent radical resection and left lower lobectomy. Immunohistochemical examination revealed a dense proliferation of spindle-shaped cells with ovoid nuclei and collagen fibers hyperplasia. The cells were positive for CD34 and vimentin, and were negative for cytokeratin AE1/AE3, calretinin, S-100 and smooth muscle α-actin. SFTPs have malignant potential, as 20-30 % of resected SFTPs reportedly contain malignant components. Careful long-term clinical follow-up is therefore required for all cases of SFTP.